Five years ago, Bill Gates predicted that a pandemic would spread very quickly, shake the global economy and transform daily life.
On Wednesday, Dr. Lloyd Minor, Dean of Stanford University School of Medicine, posed questions to the Microsoft co-founder and co-chair of the Bill & Melinda Gates Foundation about the strategies and innovations needed to end the COVID-19 pandemic that, as Gates forecast, is now sweeping the world.
Q: Where did we go wrong?
A: “There are some things we didn’t do before the epidemic hit. And then there’s the things that we didn’t do once the epidemic hit.
We can definitely say in those early days, getting the PCR machines and the commercial sector up and running, and getting them to every community with results coming back in less than 24 hours — the way that was done in South Korea, Australia, Taiwan — was a model that sadly, the U.S. did not use.
Usually, you’d expect the worst to be the ‘ground zero’ country — in this case, China, then the next wave, which was all in Asia, and then in Europe, and then finally, the U.S. We had all this community spread.
With a travel ban, where you actually force people to come back from China, you have to have a way to be able to either just assume they’re infected and quarantine them, or test them. And then if they test positive, to have that enforced quarantine.
We actually seeded a lot of infection by saying, ‘Okay, everybody, residents and citizens come back (and not testing or quarantining).’
Diagnostics and quarantine — we knew those were important. We didn’t do a good job executing on them.”
Q: How do we rebuild the public health infrastructure in our country?
A: “The CDC is the best in the world. Everyone in the world looks to the CDC, whether it’s how you message during a pandemic, how you do the epidemiology or how you track the data. In some respects, we have under invested in practicing those skill sets, making sure the database system really would pull the information together in a rich way.
I’d say overwhelmingly, we didn’t take advantage of that expertise, because we didn’t take the spokespeople in the CDC and give them the opportunity to be the voice. Now, to some degree, Dr. Fauci — who’s fantastic — once in awhile he is allowed to go out and talk and so he’s carried out the public health mission.
But by not having a consistent message, by not having the federal government say, early on, ‘We need to intervene aggressively,’ we missed what capacity there is at the CDC to minimize the epidemic.
The U.S. also (cut) the people who would have bought the materials and who would have gathered the information.
Q: What’s the course of economic recovery going to be?
A: “One thing I underestimated was how quickly people’s behavior would change. And that when death stalks the land and you’ve got thousands of deaths going on a day, I didn’t realize how much people would say: ‘Let’s not go into work.’ ” (In a 2015 talk), I talked about $3 trillion economic costs. It’ll easily get to $10 trillion, perhaps even $15 trillion, overall.
Q: How are we going to democratize the distribution of vaccines, both within our country and then in the world?
A: “Let me talk a tiny bit about the vaccine business. It is largely six or seven Western companies that invent the novel vaccines. And then as they get out there in developing countries, the manufacturers — mostly in India, but Indonesia, Brazil, a few other places — they’ll make a different version of the vaccine and sell it at a much lower price.
“This is not a case where you want to use just a market-based approach, charging the highest price you can for the vaccine and getting it to just the richest patient for the richest countries.
We have a lot of vaccines underway. The ones that really count are the ones that are going to go through a ‘gold standard’ regulator, which would be the U.S. FDA or the European regulator. All the countries in the world look at those kind of blessings before they say, ‘Okay, this is quite safe.’
We’ve got six vaccines that U.S. and other monies is funding into Phase Three trials. And potentially, we’re going to have an Emergency Use license for two or three of them coming in the first half of next year.”
Q: How much capacity do these manufacturers have?
A: We have the capacity to go way faster than for any vaccine in history.
This is the first time ever in history (that) we’re going to have a vaccine invented by a Western company, such as Johnson & Johnson, partnering with the Indian company Biological E, which has an even bigger factory and will have the right to manufacture. Likewise, the British-Swedish company AstraZeneca has a vaccine licensing agreement with Serum Institute of India.
So overall, thank goodness, our ability to create vaccines, and the many different approaches we can use, gives us the high likelihood of one, or multiples of them, working.”
Q: What is your assessment of the therapeutic landscape today?
A: “The thing that’s most promising in this whole space is the monoclonal antibodies. If you catch somebody early — someone who just tested positive — and then give these antibodies either as an infusion or a couple of shots, you probably will be able to reduce the death rate 70% or 80%.
There’s a lot of great work going on in this space. Particularly if it’s a low dose intervention, that really is a big deal in reducing overall deaths.”
Q: What are the prospects for global screening of the emergence of another new virus?
A: “We always have to be serious about public health in a global sense and surveillance for ‘the next one,’ because we don’t know where it will emerge.”
